Care Management Coordinator

Job Description

Job Overview:

The Care Management Coordinator is responsible for overseeing the processes and documentation that occur as evidence based practice is applied at the bedside. Directs and or completes all functions of the government and commercial utilization management process. Assesses and coordinates implementation of the discharge plan. Collaborates with the multidisciplinary team to assure effective, efficient, appropriate care in order to optimize the health status and assure a smooth transition between levels of care for patients served. Performs utilization review for patients served. Requires weekend, holiday, and off site commitment, with the exception of Hospice of Cincinnati.

Job Requirements:

Associate's Degree or Diploma in Nursing
Hires into position (internal and external) required to obtain BSN within 5 years of hire
BLS/CPR (Basic Life Support for Healthcare Providers)
Registered Nurse
Excellent communication skills
Ability to negotiate
Problem solve
Establish effective working relationship with members of the healthcare team and external customers Knowledge & experience in computer key boarding
Professional organization membership preferred
3-4 years experience Clinical in Nursing


Job Responsibilities:

Using current practice guidelines, assesses all patients, evaluating progress toward clinical goals and next level of care. Reassesses as clinical condition changes.

Complete initial utilization review using Interqual criteria. Take follow up action to resolve the situation when criteria are not met by implementing and documenting according to the Utilization Review plan.

Coordinate the development of a comprehensive plan of care through patient/family involvement in an interdisciplinary team process. Ensure the patient's health care goals are met related to evidenced based quality care.

Ensure that all commercial and government payment requirements are met for continued stay reviews, and other conditions of participation. Ensure that CMS requirements are met for patient status.

Other Job-Related Information:

The TriHealth Nursing Vision, Mission, and Philosophy speaks to professional development, collaboration, and our nursing culture. To achieve excellence in nursing care, TriHealth encourages: pursuit of improved knowledge through continuing education classes, formal education leading to advanced degrees, and the attainment of specialty certification; nurse membership in local, regional, and national nursing organizations related to the appropriate nurse specialty; involvement in activities that better the health of our community; nursing research activities and use of evidence-based practice, and all nurses to foster, support, and personally model collaborative relationships amongst nurses, physicians, and other caregivers for the betterment of patient care.

Working Conditions:

Climbing - Rarely
Concentrating - Consistently
Continous Learning - Consistently
Hearing: Conversation - Consistently
Hearing: Other Sounds - Consistently
Interpersonal Communication - Consistently
Kneeling - Occasionally
Lifting <10 Lbs - Frequently
Lifting 50+ Lbs - Occasionally
Lifting <50 Lbs - Frequently
Pulling - Frequently
Pushing - Frequently
Reaching - Occasionally
Reading - Consistently
Sitting - Frequently
Standing - Frequently
Stooping - Occasionally
Talking - Consistently
Thinking/Reasoning - Consistently
Use of Hands - Consistently
Color Vision - Consistently
Visual Acuity: Far - Consistently
Visual Acuity: Near - Consistently
Walking - Frequently

TriHealth SERVE Standards and ALWAYS Behaviors
At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following:


Serve: ALWAYS...
• Welcome everyone by making eye contact, greeting with a smile, and saying "hello"
• Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist
• Refrain from using cell phones for personal reasons in public spaces or patient care areas
Excel: ALWAYS...
• Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met
• Offer patients and guests priority when waiting (lines, elevators)
• Work on improving quality, safety, and service
Respect: ALWAYS...
• Respect cultural and spiritual differences and honor individual preferences.
• Respect everyone's opinion and contribution, regardless of title/role.
• Speak positively about my team members and other departments in front of patients and guests.
Value: ALWAYS...
• Value the time of others by striving to be on time, prepared and actively participating.
• Pick up trash, ensuring the physical environment is clean and safe.
• Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.
Engage: ALWAYS...
• Acknowledge wins and frequently thank team members and others for contributions.
• Show courtesy and compassion with customers, team members and the community